WO2013037386A1 - Configuration de trou de verrouillage pour clou intramédullaire - Google Patents

Configuration de trou de verrouillage pour clou intramédullaire Download PDF

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Publication number
WO2013037386A1
WO2013037386A1 PCT/EP2011/004657 EP2011004657W WO2013037386A1 WO 2013037386 A1 WO2013037386 A1 WO 2013037386A1 EP 2011004657 W EP2011004657 W EP 2011004657W WO 2013037386 A1 WO2013037386 A1 WO 2013037386A1
Authority
WO
WIPO (PCT)
Prior art keywords
hole
intramedullary nail
orientation
driving end
transponder
Prior art date
Application number
PCT/EP2011/004657
Other languages
English (en)
Inventor
Claudia Graca
Annika Homeier
Ilan Howling
Edgar Kaiser
Original Assignee
Stryker Trauma Gmbh
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Stryker Trauma Gmbh filed Critical Stryker Trauma Gmbh
Priority to AU2011376744A priority Critical patent/AU2011376744B2/en
Priority to JP2014528870A priority patent/JP5980333B2/ja
Priority to CN201180073503.6A priority patent/CN103796599B/zh
Priority to PCT/EP2011/004657 priority patent/WO2013037386A1/fr
Priority to CA2847599A priority patent/CA2847599C/fr
Priority to ES11761010.5T priority patent/ES2587762T3/es
Priority to US14/343,875 priority patent/US9408645B2/en
Priority to EP11761010.5A priority patent/EP2755580B1/fr
Publication of WO2013037386A1 publication Critical patent/WO2013037386A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1707—Guides or aligning means for drills, mills, pins or wires using electromagnetic effects, e.g. with magnet and external sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/397—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient

Definitions

  • the invention generally relates to an intramedullary nail.
  • the invention relates to a locking hole arrangement provided at a non-driving end portion of an intramedullary nail, wherein this end portion of the nail is adapted to be positioned at a distal end portion of a humerus or a tibia, or at a proximal or at a distal end portion of a femur.
  • the proximal end of the bone is the end of the bone being oriented toward the heart of the human body.
  • the distal end of the bone is the end of the bone being oriented away from the heart of the human body.
  • An intramedullary nail may be a femur nail, a humerus nail or a tibia nail, wherein the intramedullary nail comprises a non-driving end and a driving end.
  • the non-driving end is the end of the nail which firstly enters the intramedullary channel of a bone. Entering the bone from the proximal end of the bone is denoted as antegrade insertion.
  • a nail adapted to be implanted from the proximal end of the tibia may be denoted as antegrade tibia nail
  • a nail adapted to be implanted from the distal end of the femur may be denoted as retrograde femur nail
  • a nail adapted to be implanted from the proximal end of the femur may be denoted as antegrade femur nail
  • a nail adapted to be implanted from the proximal end of the humerus may be denoted as antegrade humerus nail.
  • a different locking pattern of the non- driving end portion of an intramedullary nail exists for each one of different nails, e.g. humerus, tibia, femur nails. Locking of the non-driving end portion of an intramedullary nail is performed mostly freehand.
  • US 6,547,791 Bl discloses a tibia nail for retrograde implantation, comprising a tube with a continuous longitudinal bore and including a first anchoring portion with several cross-bores at its non-driving end portion, an adjoining connecting portion, a shank and a second anchoring portion at its driving end portion.
  • the arrangement of the cross-bores permits to fix several fragments at their positions in the region of the tibia plateau, i.e. at the proximal end portion of the tibia.
  • an intramedullary nail comprises a driving end portion and a non-driving end portion with a longitudinal axis.
  • the non-driving end portion comprises a locking hole arrangement with four holes, i.e. a first hole, a second hole, a third hole, and a fourth hole.
  • the four holes are arranged as a sequence from the non-driving end of the intramedullary nail in a direction to the driving end of the nail, with the first hole arranged closer to the non-driving end than the second hole, the second hole arranged closer to the non-driving end than the third hole, and the third hole arranged closer to the non-driving end than the fourth hole.
  • the first hole and the fourth hole have a corresponding first orientation and the second hole and the third hole have a corresponding second orientation.
  • the first orientation is a medio-lateral orientation and the second orientation is an anterior-posterior orientation.
  • the medio- lateral orientation and the anterior-posterior orientation are substantially orthogonal with respect to each other.
  • orthogonal may include in this context an angle between 80 and 100 degrees.
  • orientation of the first and fourth holes of the locking hole arrangement at the non-driving end portion of the intramedullary nail may also be different to orthogonal relative to the orientation of the second and third holes, as long as this orientation is well defined and, thus, known.
  • the orientation may be 60 degrees or may be 45 degrees.
  • the first, second, third and fourth holes are respectively adapted for receiving a locking screw.
  • Such an arrangement of locking holes may be particularly usable at a non-driving end portion of an antegrade humerus nail, an antegrade tibia nail, an antegrade femur nail as well as a retrograde femur nail.
  • At least one of the first hole, the second hole, the third hole and the fourth hole is orthogonally oriented with respect to the longitudinal axis of the non-driving end portion. It is noted that also an orientation not orthogonally with respect to the longitudinal axis may be provided. It may be, that all holes are inclined in a same way relative to the longitudinal axis, but also that at least one hole is inclined in another way as the other ones. According to another embodiment of the invention, a distance between a centre axis of the first hole and the centre axis of the second hole corresponds to a distance between a centre axis of the third hole and a centre axis of the fourth hole.
  • the distances from a non-driving end of the intramedullary nail to a respective centre axis of a hole may be as follows:
  • a distance from the non-driving end to the centre axis of the first hole may be 4 to 44 mm, preferably 5 mm.
  • a distance from the non-driving end to the centre axis of the second hole may be 9 to 49 mm, preferably 10 mm.
  • a distance from the non-driving end to the centre axis of the third hole may be 24 to 64 mm, preferably 25 mm.
  • a distance from the non-driving end to the centre axis of the fourth hole may be 29 to 69 mm, preferably 30 mm.
  • the intramedullary nail comprises a fifth hole, wherein a transponder may be arranged in this fifth hole.
  • the fifth hole may have the same orientation as the first hole and the fourth hole, and may be centred between the second hole and the third hole, as well as between the first hole and the fourth hole.
  • the distance from the non-driving end of the intramedullary nail to the fifth hole may be 16.5 to 56.5 mm, preferably 17.5 mm.
  • the five holes are equally spaced from each other.
  • the transponder may be adapted for generating a signal with a first preferred radiation direction in which the signal has specific symmetry characteristics, allowing the determination of the orientation of the first preferred radiation direction.
  • the signal symmetry characteristics may be the characteristics of a dipole.
  • the first preferred direction may be the axis of the dipole.
  • the dipole signal characteristics may be generated by a coil.
  • the transponder may be adapted for generating a signal being indicative for determining at least one of a spatial position and spatial orientation of the transponder so as to allow determining a respective spatial position and spatial orientation of at least one of the first, second, third and fourth holes, based on a predetermined spatial position and spatial orientation of the respective hole with respect to the transponder.
  • first preferred radiation direction may be aligned with the orientation, i.e. the centre axis of the fifth hole.
  • a second preferred radiation direction may be orthogonal to the first preferred radiation direction.
  • At least one of the first hole, the second hole, the third hole, the fourth hole and the fifth hole comprises a thread.
  • a locking screw and alternatively a transponder may be reliably arranged and fixed within one of the holes.
  • a combination of an intramedullary nail, as described above, with a targeting detector is provided, wherein the targeting detector is arranged to detect the signal generating by a transponder at the intramedullary nail.
  • the targeting detector may further be arranged to detect the orientation of the transponder, wherein the detector is adapted for signalling the correspondence of the orientation of at least one of the first hole, the second hole, the third hole and the fourth hole on the one hand, and a targeting orientation on the other hand, based on a predetermined spatial position and a spatial orientation of the respective first hole, second hole, third hole and fourth hole with respect to the transponder.
  • the targeting detector may be located at a tool for introducing a locking screw, helping a physician to localize the locking hole in the non-driving end portion of the intramedullary nail during a so-called freehand introduction of a locking screw.
  • the targeting detector may be located at a targeting device having a coupling portion adapted to be coupled to the driving end portion of the
  • the targeting device may further comprise a drilling gauge with a drilling axis, for easily introducing a locking screw into a respective locking hole in the non-driving end portion of the intramedullary nail.
  • US 7,686,818 B2 the disclosure of which is incorporated herein by reference, relates to a locking nail and stereotaxic apparatus thereof.
  • US 2008/0170473 Al the disclosure of which is also incorporated herein by reference, relates to a targeting system.
  • Fig. 1 illustrates an isometric view of an end portion of an intramedullary nail according to the invention.
  • Fig. 2 is a side view of an intramedullary nail according to the invention.
  • Fig. 3 is a section view of the end portion of the intramedullary nail according to the invention.
  • Fig. 4 is an isometric view of a hole including a thread according to the invention.
  • Fig. 5 is an isometric view of a hole including a transponder according to the invention.
  • Fig. 6 is a side view of a combination of an intramedullary nail and a targeting device.
  • Fig. 1 is an isometric view of a non-driving end portion 20 of an intramedullary nail 1.
  • the non-driving end portion 20 includes a longitudinal axis 21, a non-driving end 22 and a longitudinal bore 23 arranged substantially parallel to the longitudinal axis 21.
  • the non-driving end 22 is formed as a blunt end of the intramedullary nail 1. Furthermore, five holes are illustrated in Fig. 1.
  • the intramedullary nail 1 comprises a first hole 31 with a centre axis 3 la, a second hole 32 with a centre axis 32a, a fifth hole 35 with a centre axis 35a, a third hole 33 with a centre axis 33a, and a fourth hole 34 with a centre axis 34a.
  • the first hole 31 , the fifth hole 35 and the fourth hole 34 are orientated in a first orientation
  • the second hole 32 and the third hole 33 are orientated in a second orientation.
  • Each of the centre axes of the holes is oriented orthogonal to the longitudinal axis 21. Furthermore, the first hole 31 and the fourth hole 34 are orientated orthogonal to the second hole 32 and the third hole 33.
  • the fifth hole 35 is arranged in the middle between the first and fourth holes, orientated in the same direction as the first and fourth holes. The fifth hole 35 is adapted for receiving a transponder. Additionally, in Fig. 1 the directions medio-lateral ML and anterior-posterior AP are illustrated.
  • Fig. 2 is a side view of the intramedullary nail in the medio-lateral direction.
  • a transponder 50 may be arranged in the fifth hole, in the middle between the first hole 31 and the fourth hole 34.
  • the visual part of the transponder has a greater diameter than the respective diameter of the first and fourth holes.
  • Further illustrated in Fig. 2 are the distances between some of the centre axes of the holes. The distance between the centre axis of the first hole 31 and the centre axis of the fourth hole 34 is indicated as dl .
  • the distance between the centre axis of the first hole 31 and the centre axis 32a of the second hole 32, as well as the distance between the centre axis 33a of the third hole 33 and the centre axis of the fourth hole 34 is indicated as d2, that is, the distance between the centre axes of the first and second holes is equal to that of the third and fourth holes.
  • the distance between the centre axis of the fourth hole 34 and the centre axis of the fifth hole with the transponder 50 is indicated as dl/2, that is, the transponder is arranged in the middle between the first and fourth holes.
  • a driving end portion 10 of the intramedullary nails 1 is illustrated in fig. 2. It is noted that the driving end portion 10 may have any shape or size, depending as to whether the intramedullary nail 1 should be used as humerus nail, as tibia nail or as femur nail.
  • Fig. 3 is a section view of the non-driving end portion 20 along the plane A-A of Fig. 2.
  • the intramedullary nail 1 has a hollow shaft (due to the longitudinal bore 23) with a longitudinal axis 21 at its non-driving end portion 20.
  • the first, fourth and fifth hole are illustrated parallel to each other and in a first orientation, within the plane of the figure, and the second and third holes are illustrated parallel to each other and in a second orientation, perpendicular to the plane of the figure.
  • Fig. 4 is an isometric view showing, in detail, one of the holes 31, 32, 33, 34 and 35 of the non-driving end portion of the intramedullary nail 1.
  • the hole in fig. 4 includes a thread 38 and a chamfer 39.
  • the chamfer 39 may facilitate an introduction of a screw or of a transponder into the hole.
  • the thread 38 may be provided in only one of or at least one of as well as in every one of the holes in the non-driving end portion of the intramedullary nail.
  • the holes may also comprise only a chamfer 39 and no thread 38.
  • Fig. 5 is a detailed view of the fifth hole 35 with a transponder 50 located within the fifth hole. Additionally, a first preferred radiation direction 51 of the transponder 50 and a second preferred radiation direction 52 of the transponder 50 are illustrated.
  • the first preferred radiation direction 51 is substantially aligned with the centre axis of the fifth hole 35 and thus with the centre axis of the transponder 50.
  • the second preferred radiation direction 52 is orientated orthogonal to the first preferred radiation direction 51. It is noted that the second preferred radiation direction may be within a plane being orthogonal to the first preferred radiation direction.
  • Fig. 6 shows a combination of an intramedullary nail 1 together with a targeting device 100, wherein the targeting device 100 includes a portion 1 10 with a coupling portion 1 12, wherein the coupling portion 1 12 may be adapted to be coupled to the driving end portion 10 of the intramedullary nail 1. Furthermore, the targeting device 100 comprises a portion 120 including at least one drilling gauge 130 with a drilling axis 130a. The targeting device 100 is dimensioned so that the drilling axis of one of the drilling gauges 130 is aligned with, for example, the centre axis 33a of the third hole 33, and that the drilling axis of another one of the drilling gauges 130 is aligned with the centre axis 32a of the second hole 32.
  • the targeting device 100 may further comprise a targeting detector 150 arranged in a known relation to the holes of the non-driving end portion of the intramedullary nail, so that the targeting detector 150 may receive signals from the transponder 50 to be able to indicate the relative position of the respective drilling gauge relative to one of the holes of the locking hole arrangement in the non-driving end portion 20 of the intramedullary nail 1.
  • the targeting device 100 may also be orientated relative to the intramedullary nail so that drilling gauges may be aligned with the first or the fourth hole in the intramedullary nail.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Biomedical Technology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Neurology (AREA)
  • Physics & Mathematics (AREA)
  • Electromagnetism (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un clou intramédullaire qui comprend une partie extrémité d'entraînement (10) et une partie extrémité de non entraînement (20) avec un axe longitudinal (21). La partie extrémité de non entraînement comprend une configuration de trou de verrouillage avec une suite de quatre trous, en d'autres termes de l'extrémité de non entraînement à l'extrémité d'entraînement un premier trou (31), un deuxième trou (32), un troisième trou (33), et un quatrième trou (34). Le premier trou et le quatrième trou ont une première orientation correspondante et le deuxième trou et le troisième trou ont une seconde orientation correspondante.
PCT/EP2011/004657 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramédullaire WO2013037386A1 (fr)

Priority Applications (8)

Application Number Priority Date Filing Date Title
AU2011376744A AU2011376744B2 (en) 2011-09-16 2011-09-16 Intramedullary nail locking hole arrangement
JP2014528870A JP5980333B2 (ja) 2011-09-16 2011-09-16 髄内釘の係止孔の配置
CN201180073503.6A CN103796599B (zh) 2011-09-16 2011-09-16 髓内钉锁孔装置
PCT/EP2011/004657 WO2013037386A1 (fr) 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramédullaire
CA2847599A CA2847599C (fr) 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramedullaire
ES11761010.5T ES2587762T3 (es) 2011-09-16 2011-09-16 Disposición de agujero de bloqueo de clavo intramedular
US14/343,875 US9408645B2 (en) 2011-09-16 2011-09-16 Intramedullary nail locking hole arrangement
EP11761010.5A EP2755580B1 (fr) 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramédullaire

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2011/004657 WO2013037386A1 (fr) 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramédullaire

Publications (1)

Publication Number Publication Date
WO2013037386A1 true WO2013037386A1 (fr) 2013-03-21

Family

ID=44677843

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2011/004657 WO2013037386A1 (fr) 2011-09-16 2011-09-16 Configuration de trou de verrouillage pour clou intramédullaire

Country Status (8)

Country Link
US (1) US9408645B2 (fr)
EP (1) EP2755580B1 (fr)
JP (1) JP5980333B2 (fr)
CN (1) CN103796599B (fr)
AU (1) AU2011376744B2 (fr)
CA (1) CA2847599C (fr)
ES (1) ES2587762T3 (fr)
WO (1) WO2013037386A1 (fr)

Cited By (2)

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US11446072B2 (en) 2017-10-10 2022-09-20 DePuy Synthes Products, Inc. Self-retaining nail to insertion handle interface
US12004785B2 (en) 2022-04-21 2024-06-11 DePuy Synthes Products, Inc. Retrograde femoral intramedullary nail, and related systems and methods

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US8945147B2 (en) 2009-04-27 2015-02-03 Smith & Nephew, Inc. System and method for identifying a landmark
US9031637B2 (en) 2009-04-27 2015-05-12 Smith & Nephew, Inc. Targeting an orthopaedic implant landmark
EP2709542B1 (fr) * 2011-05-06 2024-04-17 Smith & Nephew, Inc. Ciblage de points de repère de dispositifs orthopédiques
US9895177B2 (en) * 2016-01-15 2018-02-20 ARTHREX, GmbH Bone fixation device for treatment of femoral fractures
US11083503B2 (en) 2016-09-22 2021-08-10 Globus Medical, Inc. Systems and methods for intramedullary nail implantation
US10492803B2 (en) 2016-09-22 2019-12-03 Globus Medical, Inc. Systems and methods for intramedullary nail implantation
CN106618710A (zh) * 2017-02-20 2017-05-10 广东工业大学 一种与股骨骨髓腔形态相匹配的近端固定髓内钉
US11633219B2 (en) 2019-06-26 2023-04-25 Globus Medical, Inc. Fenestrated pedicle nail
CN113262031B (zh) * 2021-06-28 2023-03-24 宁波兆盈医疗器械有限公司 一种胫骨髓内钉远端孔瞄准检具及其使用方法

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CA2847599C (fr) 2016-09-06
EP2755580B1 (fr) 2016-06-22
ES2587762T3 (es) 2016-10-26
CN103796599A (zh) 2014-05-14
JP5980333B2 (ja) 2016-08-31
US9408645B2 (en) 2016-08-09
EP2755580A1 (fr) 2014-07-23
AU2011376744A1 (en) 2014-03-13
CA2847599A1 (fr) 2013-03-21
US20150080893A1 (en) 2015-03-19
AU2011376744B2 (en) 2015-03-26
JP2014530646A (ja) 2014-11-20
CN103796599B (zh) 2017-03-01

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